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Mothers’ Reactions to a COVID-19 Prevention Facebook Group

Mothers’ Reactions to a COVID-19 Prevention Facebook Group

Social media platforms have been a tool for disseminating recommendations and updates on COVID-19. Christie Idiong from the University of Connecticut presented qualitative findings from the COVID-19 Health Chat program at the 43rd Annual Meeting & Scientific Sessions of the Society of Behavioral Medicine in Baltimore, MD, April 6-9 2022.

The COVID-19 Health Chat program was a 9-week Facebook-delivered intervention to provide mothers of teenage daughters with messages promoting non-pharmaceutical interventions and vaccines, teaching digital and media literacy, and supporting family communication around COVID-19.

After the intervention, the research team conducted semi-structured interviews with 30 mothers. Mothers were asked: 1) “What did you like the most about being in the Facebook group?”, 2) “What did you like least?”, 3) “What did you think of the information sources used?”, and 4) “How would you compare the quality of the information you received in this Facebook group relative to other sources of information you’ve encountered during the pandemic?”.

Responses to each question were double coded and summarized. When asked what they liked most about the program, the most common response was the reliable information provided, followed by interacting with group members. When asked what they liked least, the most common responses indicated they did not dislike anything about the group, disliked extreme opinions from other mothers, and lacked interest in the information. When asked about sources used in the Facebook feed, the most common responses said sources were credible and helpful, followed by not recalling the sources, and sources being biased. When asked how the information in the group compared to other sources they encountered in the pandemic, most participants responded it was about the same or better quality, followed by not remembering the content. Most participants indicated that information they received was reliable, helpful, and of similar or better quality than what they had previously encountered.

Future research is needed to understand how individuals in the general population determine a source of information is reliable and how prevention communication on other health topics can be disseminated with similar success.

This research is funded by a grant and supplement from the National Cancer Institute (CA192652; Dr. David Buller and Dr. Sherry Pagoto, Multiple Principal Investigators). Authors on this poster presentation include Dr. Sherry Pagoto, Christie Idiong, Joseph Divito, Kaylei Arcangel, and Haley Troy from the University of Connecticut; and Julia Berteletti, Dr. Barbara Walkosz, Dr. Gill Woodall, Alishia Kinsey, and Dr. David Buller from Klein Buendel.

COVID-19 Social Media Feed for Mothers and Teen Daughters

COVID-19 Social Media Feed for Mothers and Teen Daughters

Social media is a key channel for information on COVID-19 from government agencies, near-peers, and news media. The Health Chat team developed a social media feed that varied type of information source in posts on social distancing, COVID-19 vaccines, digital and media literacy, and family communication. Dr. David Buller from Klein Buendel presented findings from the COVID-19 social media feed at the 43rd Annual Meeting & Scientific Sessions of the Society of Behavioral Medicine in Baltimore, MD, April 6-9 2022.

A total of 303 mothers with adolescent daughters from a previous study testing a social media campaign on indoor tanning were recruited in January 2021 and enrolled in a randomized single-factor design (government agencies v. near-peer parents v. news media) of a 9-week Facebook feed with four assessments (baseline, 3-week, 6-week, and 9-week follow-ups). The feed contained five posts per week based on social cognitive theory, transportation theory, and diffusion of innovation theory. Mothers reported on social distancing and vaccine intentions for self and daughters.

Using intention-to-treat analyses, mothers’ reports of social distancing by self and daughter declined over the 9-weeks. Daughters’ social distancing declined faster in the near-peer condition but less quickly in the government condition. Vaccine intentions increased over the nine weeks in all experimental condition. Baseline intentions seemed to moderate effect of condition on change in intentions. Mothers with initially high vaccine intentions (relative to moderate intentions) assigned to the government condition reported a less steep increase in intentions over time and had slightly lower intentions to vaccinate at the end of the study. Baseline credibility of the assigned information source predicted increased vaccine intentions. However, in the near-peer condition, mothers who assigned them lower as opposed to higher credibility showed increased vaccine intentions.

Theory-based posts emphasizing information from government agencies may have provided credible counterarguments against local jurisdictions relaxing pandemic restrictions that slowed declines in daughters’ social distancing. The near-peer sources may have been influential with mothers who did not expect them to convey the credible arguments supporting vaccines which they did in the experimental feed, consistent with violations of expectations theory in persuasive communication.

This research is funded by a grant and supplement from the National Cancer Institute (CA192652; Dr. David Buller and Dr. Sherry Pagoto, Multiple Principal Investigators). Authors on this presentation include Dr. Sherry Pagoto and Joseph Divito from the University of Connecticut; Dr. Kim Henry from Colorado State University; and Dr. David Buller, Dr. Barbara Walkosz, Dr. Gill Woodall, Julia Berteletti, and Alishia Kinsey from Klein Buendel.

Dr. David Buller Presenting at SBM
Persisting Effects of the Health Chat Program

Persisting Effects of the Health Chat Program

The use of indoor tanning facilities by minors is a public health concern. In an effort to reduce risk for skin cancer, the Health Chat social media intervention was launched by Klein Buendel researchers and their colleagues to reduce mothers’ permissiveness toward their teenage daughters’ indoor tanning behavior.

For the Health Chat study, mothers with daughters aged 14-17 were recruited in 34 states that do not ban indoor tanning by minors. Participating mothers received an adolescent health social media campaign in Facebook private groups. Half of the mothers were in a group in which the health campaign included posts about preventing indoor tanning (intervention) and the other half, included posts on preventing prescription drug misuse (control). Follow-up surveys with mothers at 12 months and 18 months measured indoor tanning permissiveness, attitudes, intentions, communication, behavior, and support for state indoor tanning bans.

Analysis of the 18-month follow-up data from the Health Chat social media intervention was e-published recently in Cancer Epidemiology, Biomarkers & Prevention. The research was led by Dr. David Buller from Klein Buendel and Dr. Sherry Pagoto from the University of Connecticut.

The methods and results of this randomized trial are detailed in the publication. Data analysis showed that at 18 months after the intervention, mothers in the intervention group were less permissive of indoor tanning by daughters and had greater self-efficacy to refuse daughter’s indoor tanning requests than mothers in the control group. Intervention-group mothers also had lower intentions to indoor tan themselves and were more supportive of bans on indoor tanning by minors than control-group mothers. In addition, daughters in the intervention group expressed less positive attitudes toward indoor tanning than daughters in the control group.

In summary, the Health Chat social media intervention may have influenced mothers’ decisions to withhold permission for their daughters to indoor tan for six months after the end of the program. Mothers’ support for bans on indoor tanning by minors also appears to have persisted.

This research was funded by a grant and supplement from the National Cancer Institute (CA192652; Dr. David Buller and Dr. Sherry Pagoto, Multiple Principal Investigators). Collaborating authors include Dr. Katie Baker and Dr. Joel Hillhouse from East Tennessee State University; Dr. Kimberly Henry from Colorado State University; Jessica Bibeau from the University of Connecticut; and Dr. Barbara Walkosz, Julia Berteletti and Alishia Kinsey from Klein Buendel. 

Mothers and Teenage Daughters: HPV Vaccination Information via Social Media

Mothers and Teenage Daughters: HPV Vaccination Information via Social Media

Dr. David Buller, Klein Buendel’s Director of Research, and his coauthors have published results from the Health Chat Project in the online journal, Frontiers in Digital Health. Health Chat was designed as a social media intervention to reduce mothers’ permissiveness toward their teen daughters’ indoor tanning behavior. It also addressed other adolescent health topics, including human papillomavirus vaccination.

“Parents acquire information about human papillomavirus (HPV) vaccines online and encounter vaccine-critical content, especially on social media, which may depress vaccine uptake,” according to the authors. To help address vaccine hesitancy and misinformation, the authors employed a Facebook-delivered adolescent health campaign targeting mothers with posts on HPV vaccination. The study examined the relationship between mothers’ comments and reactions to posts about HPV and any change in their self-reports of having their daughters vaccinated.

The online publication describes the study’s hypotheses, social media health intervention, research methods, results, communication strategies, and limitations. The behavioral research was guided by social cognitive theory, transportation theory, and diffusion of innovations theory. In summary, mothers commented both positively and negatively toward HPV vaccine-related posts. Also, vaccinations rates increased from baseline, through 12-month and 18-month follow-up assessments.

This research was funded by a grant and supplement from the National Cancer Institute (CA192652; Dr. David Buller and Dr. Sherry Pagoto, Multiple Principal Investigators). Collaborating authors include Dr. Katie Baker and Dr. Joel Hillhouse from East Tennessee State University; Dr. Kimberly Henry from Colorado State University; Jessica Bibeau from the University of Connecticut; Kelsey Arroyo from the University of Florida; and Dr. Barbara Walkosz and Julia Berteletti from Klein Buendel. 

Results of a social media campaign to prevent indoor tanning by teens

Results of a social media campaign to prevent indoor tanning by teens

Results of the Health Chat social media intervention to reduce mothers’ permissiveness toward their teen daughters’ indoor tanning (IT) behavior have been published in Preventive Medicine Reports.

During the intervention, participating mothers received an adolescent health social media campaign in Facebook private groups. Half of the mothers were in a group in which the health campaign included posts about preventing IT (intervention) and the other half, included posts on preventing prescription drug misuse (control). Health Chat was designed by the research team based on an integrated conceptual framework of social cognitive theory, transportation theory, and diffusion of innovations theory.

Given mothers’ high use of social media, the research team, led by Klein Buendel Director of Research, Dr. David Buller, and Dr. Sherry Pagoto from the University of Connecticut, evaluated a social media campaign aimed at mothers to prevent IT by their daughters in a randomized trial that tested two hypotheses:

H1: The social media campaign on IT will significantly reduce (a) mother’s permissiveness regarding their daughter’s IT, (b) their daughter’s perception of maternal permissiveness toward IT, and (c) both mother’s and daughter’s IT relative to the control condition.

H2: A statistically significantly greater number of mothers will support a ban on IT for minors in the intervention group compared to the control condition.

Study methods, data, and results are detailed in the Preventive Medicine Reports’ publication and indicate that a social media campaign may be an effective strategy for convincing mothers to withhold permission for IT from their teen daughters, in an effort to reduce risk for skin cancer.

This research was funded by a grant and supplement from the National Cancer Institute (CA192652; Dr. David Buller and Dr. Sherry Pagoto, Multiple Principal Investigators). Collaborating authors include Dr. Katie Baker and Dr. Joel Hillhouse from East Tennessee State University; Dr. Kimberly Henry from Colorado State University; Jessica Bibeau from the University of Connecticut; and Dr. Barbara Walkosz and Julia Berteletti from Klein Buendel. 

Results of a Social Media Campaign to Prevent Indoor Tanning by Teens: A Randomized Controlled Trial

Results of a Social Media Campaign to Prevent Indoor Tanning by Teens: A Randomized Controlled Trial

Indoor tanning (IT) increases the risk of developing melanoma. A social media campaign to reduce mother’s permissiveness toward their teenage daughters’ IT was designed and evaluated by Dr. David Buller, Director of Research at Klein Buendel, and his research team. He gave a presentation on the Health Chat campaign at the virtual 71st Annual International Communication Association Conference, May 27-31, 2021.  

A total of 869 mothers of teenage daughters aged 14-17 in 34 states without bans on IT by minors were enrolled in a randomized controlled trial with two assessments, baseline and 12-month follow-up in 2017-19. A year-long adolescent health campaign was delivered to all participants. The intervention group received posts on preventing IT while the control group received posts about preventing prescription drug misuse. Mothers completed assessments of permissiveness for daughters to indoor tan, self-efficacy for refusing permission, communication with daughters about avoiding IT, attitudes and intentions toward IT, IT behavior, and support for state IT bans. Daughters (n=469; 54%) completed the assessments at baseline and at 12 months.  

At the 12-month follow-up, intervention-group mothers were less permissive of IT by daughters, reported more communication with daughters about avoiding IT, and had lower intentions to indoor tan than control-group mothers. Daughters confirmed intervention-group mothers communicated about IT and shared IT posts more than control-group mothers.  

Overall, a social media campaign may be an effective strategy to convince mothers to withhold permission for IT, which may help increase the effectiveness of state laws designed to reduce IT by minors by requiring parental permission.  

This research was funded by a grant and supplement from the National Cancer Institute (CA192652; Dr. David Buller and Dr. Sherry Pagoto, Multiple Principal Investigators). Collaborating authors include Dr. Sherry Pagoto and Jessica Bibeau from the University of Connecticut; Dr. Kimberly Henry from Colorado State University; Dr. Katie Baker and Dr. Joel Hillhouse from East Tennessee State University; and Dr. Barbara Walkosz and Julia Berteletti from Klein Buendel. 

Responding to COVID-19 Misinformation in a Social Media Feed

Responding to COVID-19 Misinformation in a Social Media Feed

Social media play a large role in disseminating news on COVID-19 but they also have spread misinformation. Strategies have been suggested for correcting misinformation from fact-checking to digital and media literacy. Dr. David Buller, Director of Research at Klein Buendel, is studying an approach to responding to misinformation in a social media feed on COVID-19 and the reactions of participants to responses. He gave a presentation on the research at the University of Connecticut’s virtual mHealth Conference, May 13-14, 2021.

A total of 303 mothers with adolescent daughters who had previously participated in a social media campaign on indoor tanning were recruited in January 2021 and enrolled in a single-factor design comparing information sources in a 9-week Facebook feed (government agencies v. near-peer parents v. news media) with four assessments (baseline, 3 weeks, 6 weeks, and 9 weeks). The social media feed addressed non-pharmaceutical interventions such as social distancing, COVID-19 vaccination, digital and media literacy skills, and family communication about COVID-19. A community manager scheduled posts (5 per week), monitored reactions and comments, and responded to mothers’ comments that conveyed misinformation within 24 hours following a pre-established protocol. Misinformed comments were defined as being in opposition to recommendations of scientific authorities.

Of the 135 posts total (45 per group), 13% received comments containing misinformation (54 comments) and the community manager responded to 48 of the misinformed comments. Mothers posted the most misinformation in the near-peer parent group (27 comments); those in government agency group (17 comments) and news media groups (10 comments) posted less misinformation. Most comments with misinformation were in response to vaccination posts. The community manager’s responses to misinformation acknowledged mothers’ comments and then stated facts (such as efficacy and safety of vaccines) and cited evidence-based sources (such as the CDC) to refute the misinformation. The community manager also validated mothers’ concerns and confusion, if expressed in these posts, and occasionally stated personal experience or asked a follow-up question to promote dialogue. After responses were posted, ten original posters commented again and three reacted to the reply with “like/love”. Also, at times, other moms commented, reacted, or sent a private direct message related to response to misinformation.

Feeds on COVID-19 vaccines and non-pharmaceutical interventions can attract misinformation from individuals following them. Response strategies did not appear to generate a debate with mothers who posted misinformation, possibly because it conveyed an understanding of their positions or acknowledged their uncertainty or confusion rather than confronted them. Responses seemed to garner some supportive reactions from other mothers for the community manager, perhaps because the response made them feel supported to express their disagreement with the misinformation. These reactions could serve to reinforce the correction of misinformation for other followers of the social media feed.

This research is funded by a grant and supplement from the National Cancer Institute (CA192652; Dr. David Buller and Dr. Sherry Pagoto, Multiple Principal Investigators). Collaborating authors include Dr. Sherry Pagoto and Joseph Divito from the University of Connecticut; and Dr. Barbara Walkosz, Dr. Gill Woodall, Julia Berteletti, and Alishia Kinsey from Klein Buendel.

Engagement with a Social Media Campaign for Mothers to Reduce Permissiveness for Daughters’ Indoor Tanning

Engagement with a Social Media Campaign for Mothers to Reduce Permissiveness for Daughters’ Indoor Tanning

Indoor tanning (IT) by adolescents increases lifetime risk of developing melanoma. Dr. David Buller, Director of Research at Klein Buendel, is leading an examination of a social media campaign for mothers to reduce their permissiveness toward indoor tanning by their teenage daughters. Dr. Buller presented findings on mothers’ engagement with the social media campaign – Health Chat – at the D.C. Health Communication (Virtual) Conference, April 23-24, 2021.

Several states require parents to consent or accompany minor children using IT facilities. Engagement of mothers with the social media campaign was examined to see if it modified campaign effects on mothers’ permissiveness for their teen daughters to indoor tan. Mothers (N=869) with daughters aged 14-17 were recruited in 34 states that do not ban IT by minors under 18 for a randomized trial with follow-ups at 12-month and 18-month post-randomization.

Mothers received an adolescent health social media campaign in Facebook private groups. Half of mothers were in a group in which the campaign included posts about preventing IT (intervention) and the other half, included posts on preventing prescription drug misuse (control). Engagement was measured by extracting reactions (e.g., like, sad, etc.) and comments posted by mothers to the campaign posts addressing IT or prescription drug misuse. Follow-up surveys assessed mothers’ permissiveness for daughters to indoor tan, i.e., whether mothers would permit daughters to indoor tan or facilitate them doing so (e.g., take them to a tanning facility). Daughters (n=469; 54.0%) were invited to complete baseline and follow-up assessments.

Mothers were mostly non-Hispanic white, college educated, and had household incomes exceeding $80,000. Nearly one-third had a family history of skin cancer and just over one quarter had high-risk skin types. At 12-month and 18-month follow-up, engagement with the social media campaign moderated the impact of treatment group on mothers’ permitting and facilitating IT by daughters. Specifically, among mothers who engaged with the campaign, mothers in the intervention group had lower permissiveness for IT and less facilitation of IT by their daughters than in the control group. These differences did not occur between treatment groups among mothers with no engagement in either permissiveness or facilitation at either follow-up.

Social media campaigns may be used to improve IT public policies by decreasing mothers’ permissiveness and increasing communication with daughters about avoiding IT. However, social media messages need to reach and engage mothers to be effective, in this case on convincing mothers to not permit or facilitate daughters’ request to indoor tan. Prevention messages, when interspersed in a social media feed on adolescent health, may reduce IT by female adolescents by improving compliance with public policies restricting minor access to IT facilities.

This research is funded by a grant and supplement from the National Cancer Institute (CA192652; Dr. David Buller and Dr. Sherry Pagoto, Multiple Principal Investigators). Collaborating authors include Dr. Sherry Pagoto and Jessica Bibeau from the University of Connecticut, Dr. Kimberly Henry from Colorado State University, Dr. Katie Baker and Dr. Joel Hillhouse from East Tennessee State University, and Dr. Barbara Walkosz, Julia Berteletti, and Lucia Liu from Klein Buendel.

Long-term Effects of a Social Media Campaign for Mothers to Prevent Indoor Tanning by Teens in a Randomized Trial

Long-term Effects of a Social Media Campaign for Mothers to Prevent Indoor Tanning by Teens in a Randomized Trial

Indoor tanning (IT) increases risk of developing melanoma, yet IT remains popular with some teen girls. Mothers can influence IT initiation. Dr. David Buller, Director of Research at Klein Buendel, presented long-term effects of a social media intervention for indoor tanning at the 42nd Annual (Virtual) Meeting & Scientific Sessions of the Society of Behavioral Medicine, April 12-16, 2021.

Several states require parents to consent or accompany minor children using IT facilities. Health Chat, a social media campaign was tested that aimed to reduce mothers’ permissiveness for their teen daughters to indoor tan, decrease mothers’ and daughters’ IT behavior, and increase mothers’ support for bans on IT by minors. A sample of mothers (n=869) with daughters aged 14-17 in 34 states without bans on IT by minors were enrolled in a 12-month randomized trial.

All mothers received a campaign on adolescent health in Facebook private groups containing posts on a variety of health topics (for example, substance abuse or mental health) and mother-daughter communication. In the intervention group, the campaign included posts about preventing IT, whereas in the control group, it included posts about preventing prescription drug misuse. Long-term effects were assessed by comparing mothers’ responses at baseline to responses at 18-months post-randomization. Measures assessed permissiveness for daughters to indoor tan, self-efficacy for refusing permission for IT, communication with daughters about avoiding IT, attitudes and intentions toward IT, IT behavior, and support for state bans on IT by minors. The daughters (n=469) only completed baseline and follow-up assessments.

At the 18-month follow-up, intervention-group mothers were less permissive of IT by daughters, reported more communication with daughters about avoiding IT, had greater self-efficacy to refuse daughter’s request for IT, expressed less positive attitudes toward IT, had lower intentions to indoor tan, and were more supportive of bans on IT by minors under age 18 than control-group mothers. At 18-months, daughters in the intervention group had less positive attitudes toward IT than in the control group.

Social media may be an effective channel to convince mothers to withhold permission for IT by daughters and thus reduce IT by minors in states requiring parental permission provided IT facility operators request this permission. Increased support among mothers for bans on IT might facilitate efforts to place more restrictions on IT.

This research project is funded by a grant and supplement from the National Cancer Institute (CA192652; Dr. David Buller and Dr. Sherry Pagoto, Multiple Principal Investigators). Collaborators on the conference presentation include Dr. Sherry Pagoto and Jessica Bibeau from the University of Connecticut; Dr. Katie Baker and Dr. Joel Hillhouse from East Tennessee State University; Dr. Kimberly Henry from Colorado State University; and Dr. Barbara Walkosz and Julia Berteletti from Klein Buendel.

Experiences from the Health Chat Intervention

Experiences from the Health Chat Intervention

Dr. David Buller, Director of Research at Klein Buendel, presented experiences from the Health Chat Intervention during a symposium at the 42nd Annual (Virtual) Meeting & Scientific Sessions of the Society of Behavioral Medicine, April 12-16, 2021. Health Chat is a social media intervention for mothers and their teenage daughters designed to influence their decisions related to indoor tanning.

Despite declines in recent years, indoor tanning (IT) remains popular with some adolescent females. IT initiation can be influenced by mothers’ permissiveness toward IT and IT behavior. Social media is a popular channel with mothers for adolescent health information. Our research team developed a series of social media posts to prevent IT and evaluated their impact on mothers’ permissiveness, mothers’ and daughters’ IT attitudes, intentions, and behavior, and mothers’ support for bans on IT by minors. Investigators used an iterative method to develop theory-based social media posts, based on diffusion of innovations theory, social cognitive theory, and transportation theory of narratives.

Two innovative research techniques were employed. First, to stimulate engagement with the IT messaging, posts were embedded in a larger social media campaign on adolescent health (for example, substance abuse, diet and physical activity, and mental wellness), with 2-3 posts on IT (about 113 posts total) among the 14 health posts per week (about 710 posts total). Frequency and currency of IT posts were adjusted to avoid message fatigue and disengagement. Second, the campaign was delivered to in two Facebook private groups to create experimental separation, with control-group mother receiving posts on preventing prescription drug misuse. Recruitment was challenging with initial community-based techniques (such as schools, community groups/events, and out-calls) being largely unsuccessful.

The sample of mothers (n=869) was ultimately obtained from the Qualtrics Internet Panel from 34 states without bans IT by minors. They completed assessments at baseline and 12- and 18-months post randomization. Daughters were invited to complete baseline and follow-up assessments but just over half did so at baseline. Most mothers (87%) stayed in the private groups for the entire 12-month campaign and 277 mothers engaged with the IT posts. The effects of the IT posts in 12- and 18-months follow-ups were most evident in mothers’ reduced permissiveness and increased communication with daughters about the harms of IT. It also reduced mothers’ intentions to indoor tan. At the long-term follow-up, the campaign increased mothers’ support for bans on IT by minors and self-efficacy to refuse IT request from daughters. While there was no direct effect on mothers’ or daughters’ IT behavior, these changes may serve to prevent daughters from engaging in IT in the future. They also could help to support public policy efforts to curb further IT by minors.

This research project is funded by a grant and supplement from the National Cancer Institute (CA192652; Dr. David Buller and Dr. Sherry Pagoto, Multiple Principal Investigators).

Listen to the Health Chat presentation: